Hookah smoking: a popular alternative to cigarettes.

Hookah smoking has recently emerged as a popular alternative to cigarette smoking, particularly among young adults. The perception that hookah smoking is cleaner and less harmful than cigarette smoking appears to be key to its increased use, although this is not the case. Hookah tobacco smoking delivers the powerful addictive drug nicotine, higher levels of carbon monoxide than a cigarette as well as many of the carcinogens in cigarette smoke. There is also significantly increased risk associated with secondhand smoke from hookah smoke. Communal hookah use increases the risk of transmission of infectious diseases. Transition from social to individual hookah use is a critical step toward nicotine dependence as well as progression to cigarette use. Prevention and intervention in patients' tobacco use should include discussion of cigarette alternatives including hookah smoking.